Background: Older adults are the fastest growing segment of the United States population. There is an immediateneed to identify novel, cost-effective community-based approaches that promote health and well-being for olderadults, particularly those from diverse racial/ethnic and socioeconomic backgrounds. Because choral singing ismulti-modal (requires cognitive, physical, and psychosocial engagement), it has the potential to improve healthoutcomes across several dimensions to help older adults remain active and independent. The purpose of this studyis to examine the effect of a community choir program (Community of Voices) on health and well-being and toexamine its costs and cost-effectiveness in a large sample of diverse, community-dwelling older adults.Method/design: In this cluster randomized controlled trial, diverse adults age 60 and older were enrolled atAdministration on Aging-supported senior centers and completed baseline assessments. The senior centers wererandomly assigned to either start the choir immediately (intervention group) or wait 6 months to start (control).Community of Voices is a culturally tailored choir program delivered at the senior centers by professional musicconductors that reflects three components of engagement (cognitive, physical, and psychosocial). We describe thenature of the study including the cluster randomized trial study design, sampling frame, sample size calculation,methods of recruitment and assessment, and primary and secondary outcomes.Discussion: The study involves conducting a randomized trial of an intervention as delivered in “real-world”settings. The choir program was designed using a novel translational approach that integrated evidence-basedresearch on the benefits of singing for older adults, community best practices related to community choirs for olderadults, and the perspective of the participating communities. The practicality and relatively low cost of the choirintervention means it can be incorporated into a variety of community settings and adapted to diverse culturesand languages. If successful, this program will be a practical and acceptable community-based approach forpromoting health and well-being of older adults.

Purpose

To conduct and evaluate a two-phased community-based approach to recruit lower socioeconomic status, minority, or Spanish-speaking adults at risk of developing diabetes to a randomized trial of a lifestyle intervention program delivered by a public health department.

Design

Within geographic areas comprising our target population, 4 community organizations provided local space for conducting the study and program. Phase I-outreach in venues surrounding these organizations-included diabetes education, a short diabetes risk appraisal (DRA), and diabetes risk screening based on a fasting fingerstick glucose test. Phase II-trial recruitment-began concurrently for those found to be at risk of developing diabetes in Phase I by explaining the study, lifestyle program, and research process. Those interested and eligible enrolled in the 1-year study. 

Results

Over 2 years, approximately 5,110 individuals received diabetes education, 1,917 completed a DRA, and 1,164 were screened of which 641 (55%) had an elevated fingerstick result of ≥ 106 mg/dl. Of the study sampling frame-persons over age 25 at risk of developing diabetes (N = 544)-238 (43%) enrolled in the trial; of those who were study eligible (n = 427), 56% enrolled. In the final sample, mean age was 56 years (SD = 17), 78% were ethnic minorities, 32% were Spanish-speaking, and 15% had a high school education or less.

Implications

Providing diabetes health education and screening prior to study recruitment may help overcome barriers to research participation in underserved communities, thus helping address difficulties recruiting minority and older populations into research, particularly research pertaining to chronic disease risk factors.